TY - JOUR
T1 - Variables of importance in the Scientific Registry of Transplant Recipients database predictive of heart transplant waitlist mortality
AU - Transplantation of HEarts to MaxImize Survival (THEMIS) Investigators
AU - Hsich, Eileen M.
AU - Thuita, Lucy
AU - McNamara, Dennis M.
AU - Rogers, Joseph G.
AU - Valapour, Maryam
AU - Goldberg, Lee R.
AU - Yancy, Clyde W.
AU - Blackstone, Eugene H.
AU - Ishwaran, Hemant
N1 - Funding Information:
Research reported in this manuscript was supported by the National Heart, Lung and Blood Institute of the National Institute of Health under Award Number R01HL141892. The content is solely the re‐ sponsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding Information:
Research reported in this manuscript was supported by the National Heart, Lung and Blood Institute of the National Institute of Health under Award Number R01HL141892. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2019/7
Y1 - 2019/7
N2 - The prelisting variables essential for creating an accurate heart transplant allocation score based on survival are unknown. To identify these we studied mortality of adults on the active heart transplant waiting list in the Scientific Registry of Transplant Recipients database from January 1, 2004 to August 31, 2015. There were 33 069 candidates awaiting heart transplantation: 7681 UNOS Status 1A, 13 027 Status 1B, and 12 361 Status 2. During a median waitlist follow-up of 4.3 months, 5514 candidates died. Variables of importance for waitlist mortality were identified by machine learning using Random Survival Forests. Strong correlates predicting survival were estimated glomerular filtration rate (eGFR), serum albumin, extracorporeal membrane oxygenation, ventricular assist device, mechanical ventilation, peak oxygen capacity, hemodynamics, inotrope support, and type of heart disease with less predictive variables including antiarrhythmic agents, history of stroke, vascular disease, prior malignancy, and prior tobacco use. Complex interactions were identified such as an additive risk in mortality based on renal function and serum albumin, and sex-differences in mortality when eGFR >40 mL/min/1.73 m. Most predictive variables for waitlist mortality are in the current tiered allocation system except for eGFR and serum albumin which have an additive risk and complex interactions.
AB - The prelisting variables essential for creating an accurate heart transplant allocation score based on survival are unknown. To identify these we studied mortality of adults on the active heart transplant waiting list in the Scientific Registry of Transplant Recipients database from January 1, 2004 to August 31, 2015. There were 33 069 candidates awaiting heart transplantation: 7681 UNOS Status 1A, 13 027 Status 1B, and 12 361 Status 2. During a median waitlist follow-up of 4.3 months, 5514 candidates died. Variables of importance for waitlist mortality were identified by machine learning using Random Survival Forests. Strong correlates predicting survival were estimated glomerular filtration rate (eGFR), serum albumin, extracorporeal membrane oxygenation, ventricular assist device, mechanical ventilation, peak oxygen capacity, hemodynamics, inotrope support, and type of heart disease with less predictive variables including antiarrhythmic agents, history of stroke, vascular disease, prior malignancy, and prior tobacco use. Complex interactions were identified such as an additive risk in mortality based on renal function and serum albumin, and sex-differences in mortality when eGFR >40 mL/min/1.73 m. Most predictive variables for waitlist mortality are in the current tiered allocation system except for eGFR and serum albumin which have an additive risk and complex interactions.
KW - Scientific Registry for Transplant Recipients (SRTR)
KW - artificial organs/support devices: heart/ventricular assist devices
KW - clinical research/practice
KW - gender
KW - health services and outcomes research
KW - heart transplantation/cardiology
KW - organ procurement and allocation
KW - organ transplantation in general
KW - patient survival
KW - waitlist management
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U2 - 10.1111/ajt.15265
DO - 10.1111/ajt.15265
M3 - Article
C2 - 30659754
AN - SCOPUS:85061447546
SN - 1600-6135
VL - 19
SP - 2067
EP - 2076
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 7
ER -